Healthcare Provider Details

I. General information

NPI: 1225231657
Provider Name (Legal Business Name): REGINA M. GUMUCIO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 GREEN ST
WOODBRIDGE NJ
07095-3353
US

IV. Provider business mailing address

34 GREEN ST
WOODBRIDGE NJ
07095-3353
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-3444
  • Fax: 732-634-7269
Mailing address:
  • Phone: 732-634-3444
  • Fax: 732-634-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI015210
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: